I am a frustrated parent of a six-year-old child who is currently in the hospital for a bone infection. It seems like there are too many cooks in the kitchen. The pediatrician, the orthopedic surgeon, and the nurses all seem to have different opinions about how to handle this case. How in the world does a parent navigate this kind of situation? I'm at my wit's end.
You may have heard (or even used) the expression: easier said than done. That phrase is never truer than when changing the way complex health problems are addressed in a hospital setting. And that is especially true for osteomyelitis (deep infection of bone and/or muscle) in children. This is a condition that requires close communication and coordination of many hospital services (e.g., admission department, medical staff, laboratory and imaging studies, surgical staff, and discharge processing). A common sense approach is always welcomed. But evidence-based guidelines for evaluation, diagnosis, and treatment are needed to ensure optimal treatment and results. That's why the staff at Children's Medical Center of Dallas Texas created their own evidence-based clinical practice guidelines (CPGs) and then tested the impact of following these CPGs. They worked together as a multidisciplinary team to develop and put into practice a method for dealing with children admitted to their hospital with possible musculoskeletal infections. The group included staff members from admissions, orthopedics, pediatrics, anesthesiology, hematology, radiology, emergency department, infectious disease, nursing, and social work. They developed a flow-chart (algorithm) to use when evaluating children with suspicious signs of osteomyelitis. The report they published of their results includes a printed copy of this chart from initial admission to final discharge. They used this method with 61 children admitted over a period of one year. One of the reasons the group put together their own clinical practice guidelines (CPGs) is because they observed wide variations in how children were evaluated, diagnosed, and treated for this condition in their own hospital. For example, there were 33 different antibiotics used in Group I (the 210 children with osteomyelitis treated before the CPGs were developed). The results were so dramatic (significantly improved outcomes in group II) that the following recommendations were made and started at this hospital: